Quality is need and work

Five Tips for Publishing Your QI Work

By IHI Open School | Wednesday, February 10, 2016

Quality improvement work isn’t done until you’ve shared it.

So says Dr. Greg Ogrinc, a foremost expert in QI publishing, who helped establish the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines. Dr. Ogrinc, Director of the Quality Literature Program and Senior Associate Dean for Medical Education at Dartmouth Medical School, presented his tips for publishing QI work to IHI Open School students on a recent Global Chapter Call. You can access the full recording here.

Here are a few of Dr. Ogrinc’s tips for sharing (and doing) QI work:

The goal of publishing your QI work is to help others apply the learning to their settings. It’s different from reporting the results of a randomized trial. For example, one of the most famous QI projects, known as the Keystone project or the Michigan Study, reported incredible results in reducing catheter-related bloodstream infections (CLABSIs) using a simple checklist with five steps known to reduce such infections. However, the report wasn’t clear about the process for implementing the checklist, so it was difficult for others to replicate the change. Like the checklist implementation, most QI projects require a socio-technical change in a complex system. Remember that when you publish your QI work, you’re trying to help other people understand what you did to get results — not just the results themselves.

Use a clear theoretical model to frame your QI work. Sharing your method — whether it’s the Model for Improvement, Lean, or Six Sigma — isn’t as important as the theory behind why you chose that model. Why did you think certain changes would result in improvement? What was the system that you wanted to change? How were various components interacting in the system?

Describe the context as clearly as possible.The goal of improvement is to make care better in your own local setting, so readers will be thinking about their context as they read about your work. This isn’t just the care setting — it’s also all the internal and external factors that are affecting the outcome. It’s also helpful to describe how the context evolved over the course of your work — Did the culture change? Did new technology become available? Did you find leadership support?

It’s very important to have strong data analysis. You don’t need the depth of data that you would for a typical randomized trial; however, showing data over time using run charts is essential.

Qualitative data matters, too. Where possible, use quotes and representative stories to help readers understand how your results unfolded. For example, you might consider listing the drivers of change and how each of your tests related to those drivers. Tell the story of your work.

“System awareness and systems design are important for health professionals, but they are not enough. They are enabling mechanisms only. It is the ethical dimensions of individuals that are essential to a system’s success. Ultimately, the secret of quality is love.”
-Avedis Donabedian